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17A-180 (3) 7 f 1 / i Lt ScJ+^ 1rc,vet-�1 ' t -bfC. Li i--1 1 R 0 C cc,d► r 1i n _y 1MORTGAGE LOAN INSPECTION THIS PLAT IS FOR IDENTIFICATION PURPOSES ONLY- AND DOES NOT CONSTITUTE A PROPERTY SURVEY 80'± '1 1/4 I� L. 44 � N 0 r r-- 1 STORY W/F HOUSE 1 1 1 t 1 � 1 1 =+ 1 1 0 1 1 � i !- 80't 4 NORTH MAPLE STREET THE PREMISES SHOWN ARE SUBJECT TO AND/OR TOGETHER WITH THE BENEFITS OF ANY AND ALL EASEMENTS, RIGHTS, CONDITIONS, COVENANTS, AGREEMENIJS, RESERVATIONS AND RESTRICTIONS OF RECORD. TO THE SPRINGFIELD INSTITUTION FOR SAVINGS AND THE LAWYERS TITLE INSURANCE CORPORATION - ONLY t MMpTO g� ti Gifp of Wart4amptan - , L � � �lassxcl�nsctf4 j DEPARTMENT OF BUILDING INSPECTIONS � INSPECTOR 212 Main Street • Municipal Building Northampton, MA 01060 r i HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as his/her construction sup(;: .,:sor. The state defines"Homeowner" as, " Person(s) who owns a parcel on which he/she resides or intends to be, a one or two family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a home owner." i The building department for the City of Northampton wants any person(s) who seek to use the home owner exemption, to act as their own construction supervisor, to be aware that by doing so you become responsible for compliance with state building codes and regulations. The inspection process requires that the building department be called to inspect work at various stages, which include foundation/footings (before backfill), sonotube holes (before pour), a rough building inspection (before work is concealed), insulation inspection (if required) and a final building inspection. The building department requires these inspections before the work is concealed, failure to j secure these inspections can result in failure to obtain a certificate of occupancy until the work can be inspected. If the homeowner hires other trades to perform work (electrical, plumbing& gas) the homeowner will be responsible to make sure that the trades hired secure their proper permits in conjunction to the building permit issued, and that they get their required inspections. Failure of the individual trades to secure the permits and inspections as required can DELAY the project until such time as the proper permits and inspections are made I, understand the above. (Home owner/resident's signature requesting exemption) I will call to schedule all required building inspections necessary for the building permit issued to me. Date Address of work location 4 r • 1 O �1 �- p d �i�assxcllctcctte f 111 z m DEPARTMENT 017 iUILDPI G INSPECTIONS 212 Main Street ' Municipal Duilding Northampton, Mass. 01060 r/ Wo rUC ;R'S COMTENSATION INSURANCE &FFIDAVI.T tt Ali Gl e r i cis.... ,v It a principal place of business/res" --ncc Z,- tl MA ova r y: Ile- , 5�� ° 3 3 �- tstrc°licit; CIO hCrCUy CerSI�'. ll?la [ L11C pi:iTlS anc 1)Cil?1i1��S of (--T—I am an employer providing the folio:v,rx. :.or;er s colnpensa-Lion coverage for Iny elilplovees working on this job: TY Avderj U 73 9' ► r: K' rS`/ /a 5 (I=a=a: Company) (Pc c:Number) ----- �r�pir.:don Date) ( j I am a sole proUrit tor, �l.eaeral o:Dn�c'or tlonLcowcer (c cle one'l and t-:ave iuree the contractors hsteC beiow -�v` o 't:�. the foie •.,OFkers colnpen-saDon ;,oiici;s: (Mime of Conunmor) P._L ?;1C l Cii]n?;i'r': Gi1Cf TJl1STll i) it iC' Datc)+ (Name of Colt c or) liltsur,_nc Co r_.�vPe•!icr Nlnber) (3.:c :io Date} (Name of Contractor) (IS]S r I1C l-t7 :1i7}'It oi;C: Ntr.n]}} r) x-,,:7: 0D D,ate) - (Name of Contractcr) — (Insar�ice Cclnr v;y PoLic� lvitim>;��} (_F;xr;i' ::;a Dare) -1 l_ � 1rLITI a ,�O.e i)I-Op.1l;CC?i iiI11 h�.V-' no OI.0 '.-.'U. 11ih t01- [I?C. I ill I;OIIIe OWller iiCi:OrI?11I7 all n _ ��;;*_:-�;n::�:-�s:',�an��ar:an:�•mcr::,�air.� ���c..t...,•. NO-I I,:plc:u be nsvarc tfsc•.�1 ac k,ccr,ro«Zr.:�+::o r, p. - _ not uK,cc th--n tfvroo ani s ir:t tLci-i he 1: „-,�..tiir re::,._z or a; c=ployc-3 uz,cr ttr arM-_;_ir_r.Pr ((r .152�c!(Sl ,a ._ :ic;;'try hotaro«>cz`or c l ce ct pera:i: legal rtatur of cn amPloyer under tLo Wcvl'c.'c w,-I-;•orr..lion:`.ci I undc.-ztaad d1a2 a cam,y of thi, rIStG: ft Giy fit foil,'-4j to tfi IYt a Liss of tadLutricl M vI—!y Cif v of for tlx coverk&c va,GCZIioa artd tfu t Lilac to t c u2.3: 25A of MC-L,152 c to lead to the imposition ct r ir:l pr!l;:s comisting of a fur_of uP to 51 CU.CvJ zn—"r m-,ri.r,z-:of::p to Cr.-.y;,., -.j civil perultin in d'C Ecru of Grp of S 100.40 a . n Fc.r dct:utn"'J uac crtly' I - %��' ttIIllY.J � E' � permit N -----------------_l ---- -- 3/3 �1ary.: arc - _ r r , SECTION 8-;CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder :SCo t1` 1) A/e e- e'rj G- d 1- 1 I r L License Number Levu mo QlcTy Address Expirat on Da et Telephone r Re'tig"a 75F omen m iemen" Contracto - Not Applicable ❑ Company Name Registration Number y Address Expi tion ate Telephone SECTION 10 'WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.'L c 152, § 25C(6)) " Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of he building permit. Signed Affidavit Attached Yes....... No...... ❑ The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(1) or two(2)families and to allow such homeowner to engage an individual for hire who does not possess a license, provided that the owner acts as supervisor. CMR 780, Sixth Edition Section 108.3.5.1. Definition of Homeowner: Person(s)who own a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be, a one or two family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner" shall submit to the Building Official,on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. As acting Construction Supervisor your presence on the job site will be required from time to time,during and upon completion of the work for which this permit is issued. Also be advised that with reference to Chapter 152(Workers' Compensation) and Chapter 153 (Liability of Employers to Employees for injuries not resulting in Death)of the Massachusetts General Laws Annotated,you may be liable for person(s) you hire to perform work for you under this permit. The undersigned "homeowner"certifies and assumes responsibility for compliance with the State Building Code,City of Northampton Ordinances, State and Local Zoning Laws and State of Massachusetts General Laws Annotated. Homeowner Signature _ SECTION�v ESCRfPT�VN O17V ROPOSED WORK[check aU}aool�cable) , ' r. �,.... .,�;��� �urt�na�a•..�x nwvr2ssaa. ...�<sx-s.....�...�, o :z5�::,,n,.a.._..,., „�n:„aasat,�n1_ ;:�.w�':. New House ❑ Addition Replacement Windows Alterations) ❑ Roofing O Or Doors ❑ Accessory Bldg. ❑ DemolitionO New Signs [ ] Decks [ ] Siding[ ] Other [ ] Brief Description of Proposed Work: �/�� Alteration of existing bedroom Yes V No Adding new bedroom Yes ✓ No Attached Narrative 0 Renovating unfinished basement Yes No Plans Attached Roll 0 • Sheet 0 6a.�If�ENe�""o"u e tid� ,�ditiontoezisfin �ryfiousin'm�com".le etfie�followa`n<: a. Use of building: One Family Two Family Other b. Number of rooms in each family unit: Number of Bathrooms c. Is there a garage attached? s d. Proposed Square footage of w construction. ! bi mensions / e. Number of stories? f. Method of heating? Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. Mascheck Energy Compliance form attached? h. Type of construction w i. Is construction within 100 ft. of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No j. Depth of basement or cellar floor below finished grade k. Will building conform to the Building and Zoning regulations? --"�Yes No . I. Septic Tank City Sewer ✓ Private well City water Supply SECTIOTIIa OWNER AUTHORIZATION TO BE'COMPLETED :.WHEN OWNEF(S AGENT O�tkCONTJ ACTOR APPLIES FOR BUILDING PERMIT , / / , as Owner of the subject property hereby authorize SCa rf� /�l rc l e,-tc,-� to ac;. on my be al , in all matters relative to work authorized by this building permit application. Signat re ofioker Date I -57c,, At,c- rtht tom-- as Owne uthonzed Agent hereby declare that the statements and information on the foregoing application are true and accurate, to ie �SCrP knowledge and belief. Signed under the pains and penalties of perjury. Print Name i r i i Si ent Date Section 4. ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO LACK OF INFORMATION Existing Proposed Required by Zoning This column to be filled in by p /+ Building Department Lot Size Frontage Setbacks Front Side L: f R:If / L: 1 r R: f Rear 41 '� Z Building Height a Q Bldg.Square Footage /&&J0 /07 %A /G 4-2 7q Open Space Footage Q % *� (Lot area minus bldg&paved ©Q `j T arkin ) #of Parking Spaces Fill: (volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO � DONT KNOW YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO DONT KNOW YES IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO DONT KNOW YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Obtained , Date Issued: ✓ C. Do any signs exist on the property.? YES NO IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property?YES_ No IF YES, describe size, type and location: r � pity, of Northampton 860ing Department 2GQ42' ? Main Street APR " Room 100 Northampton, MA 01060 r#" t 'o :° 3-587L240 Fax 413-587-1272 APPLICATION TO CONSTRUCT,ALTER, REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1-SITE INFORMATION Thits sechonyto be compleited!by office 1.1 Progerty Address: -�. � `Maps t lot llntt ��� C�/D� � 'Zone � ' O�►erlay District-F 7 t �em St�Dlstnct �, � r§_ ` CB,,Dlstnct SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Name(P' t) � � Current�Mailin Ac1 dre s Telephone $g Signa re 2.2 Authorized Agent: A Le wt e- AV, Zl�r.���jj� �°?/a/'Y Name(Print) Current Mailing Address: Y!-7 -7 ,7 � - n Telephone SECTION 3- ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building 3 S U o (a) Building Permit Fee 2. Electrical _ (b)Estimated,Total Cost of 1600 Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) S. Fire Protection 6. Total = (1 +2 +3 +4+5) 3 5-0 U Check Number !3 This Section.For Official,Use Only Building Permit Number: Date Issued: Signature: Building Commissioner/Inspector of Buildings Date File#BP-2004-0950 APPLICANT/CONTACT PERSON Scott Nickerson ADDRESS/PHONE 197 NORTH LEVERETT RD LEVERETT (413)367-7533 PROPERTY LOCATION 197 NORTH MAPLE ST MAP 17A PARCEL 180 001 ZONE URB THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid T_ypeof Construction- REMO E PORCH&CONSTRUCT 14 X 12 KITCHEN ADDITION New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included• Owner/Statement or License 053156 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF ATION PRESENTED: Approved Additional permits required(see below) PLANNING BOARD PERMIT REQUIRED UNDER:§ Intermediate Project: Site Plan AND/OR Special Permit With Site Plan Major Project: Site Plan AND/OR Special Permit With Site Plan ZONING BOARD PERMIT REQUIRED UNDER: § Finding Special Permit Variance* Received&Recorded at Registry of Deeds Proof Enclosed Other Permits Required: Curb Cut from DPW Water Availability Sewer Availability Septic Approval Board of Health Well Water Potability Board of Health Permit from Conservation Commission Permit from CB Architecture Committee Permit from Elm Street ommission Signature of Building Official Date Note:Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning requirements and obtain all required permits from Board of Health,Conservation Commission,Department of public works and other applicable permit granting authorities. *Variances are granted only to those applicants who meet the strict standards of MGL 40A. Contact Office of Planning&Development for more information. s 197 NORTH MAPLE ST BP-2004-095U GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 17A- 180 1 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: BUILDING PERMIT Permit# BP-2004-0950 Proiect# JS-2004-1408 Est. Cost: $37500.00 Fee: $84.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Scott Nickerson 053156 Lot Size(sq. ft.): 9583.20 Owner: PRICE HILARY B Z mi^o:UP:3 ,Ygoticant. Scott Nickerson AT.• 197 NORTH MAPLE ST Applicant Address: Phone: 197 NORTH LEVERETT RD Insurance: 413 367-7533 Workers Compensation LEVERETTMA01054 ISSUED ON. TO PERFORM THE FOLLOWING WORK:REMOVE PORCH & CONSTRUCT 14 X 12 KITCHEN ADDITION POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector Underground: Service: Meter: / f �/' Footings: �y2� Rough: Rough: 4/ House# Foundation:l 7 Driveway Final: Final: �"'�"O,�/� Final: `�/�/�i J-� Rough Frame:Q K 7-a' L Gas: Fire Department Fireplace/Chimney: Rough: 1 _ 7� Insulation:C) 0� �- Final: j-- � •�� Smoke: Final:ff jC 15• THIS PERMIT MAY BE REVOKED BY THE CITY F NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULAT/O,NS. Certificate of Occu anc ���� f si nature: FeeType: Receipt No• Date Paid: �f Check No: mount: Building 4/9/04 0:00:00 1403 $84.00 212 Main Sheet,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo